ArticleCritical care (London, England)2026
10 years trends and hospitalization outcomes of non-neonatal tetanus: a large-scale multicenter retrospective study in China.
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168 authors.
Chunxin Liu *Emergency Department, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Minli Lei *Emergency Department, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Jingjing Chen *Data and Artificial Intelligence Center, The Third Affliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
Miaoting Huang *Emergency Department, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Yaxin LuData and Artificial Intelligence Center, The Third Affliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
Yueming ChenEmergency Department, Central People's Hospital of Zhanjiang, Zhanjiang, China.
Dengfeng WuEmergency Department, Gaozhou People's Hospital, Maoming, China.
Xingcai TanEmergency Department, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.
Yuqiang LiangEmergency Department, Maoming People's Hospital, Maoming, China.
Xianwu ZhaoEmergency Department, Shantou Central Hospital, Shantou, China.
Guowei HeEmergency Department, Qingyuan People's Hospital, Qingyuan, China.
Long YuEmergency Department, Zhanjiang Agricultural Reclamation Second Hospital, Zhanjiang, China.
Mingming HuangEmergency Department, Jiangmen Central Hospital, Jiangmen, China.
Tianrong HeEmergency Department, Zhongshan City People's Hospital, Zhongshan, China.
Chi YangEmergency Department, Xinyi People's Hospital, Maoming, China.
Gengwei ZhangEmergency Department, Third People's Hospital, Shenzhen, China.
Jing XuEmergency Department, The First People's Hospital of Foshan (Foshan Hospital Affiliated to Southern University of Science and Technology), Foshan, China.
Renfeng LiaoEmergency Department, MeiZhou People's Hospital (MeiZhou City Academy of Medical Sciences), Meizhou, China.
Shaoyun LuEmergency Department, The First People's Hospital of Zhaoqing, Zhaoqing, China.
Shufa HeEmergency Department, Huaiji People' S Hospital, Zhaoqing, China.
Huizhong QiuEmergency Department, Huizhou Central People's Hospital, Huizhou, China.
Yingjie ChenEmergency Department, First Affiliated Hospital, Shantou University Medical College, Shantou, China.
Zhong ZhaoEmergency Department, Luoding People's Hospital, Luoding, China.
Jinrong LiangEmergency Department, Xinhui People's Hospital, Jiangmen, China.
Fuxing XuEmergency Department, Heyuan People's Hospital, Heyuan, China.
Shuyan LiuEmergency Department, The Eighth Affiliated Hospital of Southern Medical University (The First People's Hospital of Shunde), Foshan, China.
Yongxiang HeEmergency Department, Yuebei People's Hospital, Shaoguan, China.
Yuanjun LvEmergency Department, Kaiping Central Hospital, Jiangmen, China.
Zeqiang YuanEmergency Department, Dongguan People's Hospital, Dongguan, China.
Huangyang HeEmergency Department, Xinxing People's Hospital, Yunfu, China.
Hong DengEmergency Department, Lianzhou People's Hospital, Qingyuan, China.
Yingbo JiangEmergency Department, Southern Theater Command Navy First Hospital, Zhanjiang, China.
Weibin HuangEmergency Department, Yunfu People's Hospital, Yunfu, China.
Xianrui ZhuangEmergency Department, Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, China.
Xiaoxin QiuEmergency Department, Jieyang People's Hospital, Jieyang, China.
Qinhai LiuEmergency Department, XingNing People's Hospital, Meizhou, China.
Rui HuangEmergency Department, Zhujiang Hospital of Southern Medical University, Guangzhou, China.
Ke YangEmergency Department, Dianbai People's Hospital, Maoming, China.
Yuntao PengEmergency Department, Lufeng People's Hospital, Shanwei, China.
Yi YeEmergency Department, Nanhai District People's Hospital, Foshan, China.
Jiajie KeEmergency Department, Second Affiliated Hospital of Shantou University Medical College, Shantou, China.
Qingli DouEmergency Department, The Second Affiliated Hospital of Shenzhen University (Shenzhen Bao'an People's Hospital), Shenzhen, China.
Wenlong DengEmergency Department, Dongguan Songshan Lake Central Hospital, Dongguan, China.
Haobo ZhangEmergency Department, Foshan TCM, Foshan, China.
Xiuqun KangEmergency Department, Yuebei Second People's Hospital, Shaoguan, China.
Nan LiuEmergency Department, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
Jun ChenEmergency Department, Enping People's Hospital, Jiangmen, China.
Wenjian ZhuEmergency Department, The Affiliated Huizhou Hospital, Guangzhou Medical University, Huizhou, China.
Fengqing SongEmergency Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Yang LiuEmergency Department, Huadu District People's Hospital of Guangzhou, Guangzhou, China.
Shengnan XieEmergency Department, Deqing People's Hospital, Zhaoqing, China.
Haiyu GuEmergency Department, Guangzhou First People's Hospital, Guangzhou, China.
Wenming ShaoEmergency Department, The First Affiliated Hospital of Jinan University, Guangzhou, China.
Licheng LuoEmergency Department, Taishan People's Hospital, Jiangmen, China.
Yaowen HuangEmergency Department, Huidong People's Hospital, Huizhou, China.
Zenglong WuEmergency Department, Gaoming People's Hospital, Foshan, China.
Ping LiuEmergency Department, Sanshui District People's Hospital, Foshan, China.
Maoxiang LiaoEmergency Department, Guangdong Corps Hospital, Chinese People's Armed Police Force, Guangzhou, China.
Shusen YeEmergency Department, Dongguan Hospital of Traditional Chinese Medicine, Dongguan, China.
Xusheng TuEmergency Department, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Jianan WuEmergency Department, Fifth Affiliated Hospital of Southern Medical University, Guangzhou, China.
Mufu WuEmergency Department, Jiangmen People's Hospital, Jiangmen, China.
Yingquan ChenEmergency Department, Yangdong People's Hospital, Yangjiang, China.
Wei ZhangEmergency Department, Dongguan Tungwah Hospital, Dongguan, China.
Haiming FuEmergency Department, Longchuan People's Hospital, Heyuan, China.
Huarong DingEmergency Department, Chaozhou People's Hospital, Chaozhou, China.
Xiao ShaoEmergency Department, Guangdong Agribusiness Central Hospital, Zhanjiang, China.
Anni LouEmergency Department, Southern Medical University Nanfang Hospital, Guangzhou, China.
Yulin ChenEmergency Department, Panyu District Central Hospital, Guangzhou, China.
Zhao FanEmergency Department, Peking University Shenzhen Hospital, Shenzhen, China.
Zengliang LeiEmergency Department, Wengyuan People's Hospital, Shaoguan, China.
Jianhui YanEmergency Department, Dongguan Binhai Bay Central Hospital, Dongguan, China.
Xian ChenEmergency Department, Shunde Traditional Chinese Medicine Hospital, Foshan, China.
Na PengEmergency Department, General Hospital of Southern Theater Command, Guangzhou, China.
Wen LvEmergency Department, Shenzhen People's Hospital, Shenzhen, China.
Ying FengEmergency Department, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China.
Qing LiangEmergency Department, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Mingliang HeEmergency Department, Jiangmen Wuyi Hospital of TCM (Affiliated Jiangmen TCM Hospital of Ji'nan University), Jiangmen, China.
Zhilin HuangEmergency Department, Nanxiong People's Hospital, Shaoguan, China.
Tao LiEmergency Department, Kanghua Hospital of Dongguan, Dongguan, China.
Jun LiEmergency Department, ZhuhaiHospital of Integrated Traditional Chinese and Western Medicine, Zhuhai, China.
Wenfeng FanEmergency Department, Fogang People's Hospital, Qingyuan, China.
Zhiquan LaiEmergency Department, Xiaolan People's Hospital of ZhongShan (The Fifth People's Hospital of ZhongShan), Zhongshan, China.
Yusheng HeEmergency Department, Sixth People's Hospital of Huizhou, Huizhou, China.
Yewen ZhangEmergency Department, Fengkai People's Hospital, Zhaoqing, China.
Hanzhong QiuEmergency Department, Shaoguan First People's Hospital, Shaoguan, China.
Yang YuEmergency Department, Qingyuan Traditional Chinese Medicine Hospital, Qingyuan, China.
Yongguang HuangEmergency Department, Foshan Second People's Hospital, Foshan, China.
Dongjian LiuEmergency Department, Luoding Hospital of Traditional Chinese Medicine, Luoding, China.
Weixin QuanEmergency Department, Suixi County Hospital, Zhanjiang, China.
Huanyao ZhangEmergency Department, The Fourth Affiliated Hospital of Guangzhou Medical University (Zengcheng District People's Hospital), Guangzhou, China.
Jifeng LiEmergency Department, Second People's Hospital of Shantou, Shantou, China.
Liping WuEmergency Department, Yangjiang People's Hospital, Yangjiang, China.
Tao YiEmergency Department, Longgang Central Hospital, Shenzhen, China.
Wensheng WuEmergency Department, Shanwei People's Hospital, Shanwei, China.
Sheng XieEmergency Department, Boluo County People's Hospital, Huizhou, China.
Wenhui HuangEmergency Department, Rongcheng City Central Hospital, Jieyang, China.
Yue YangEmergency Department, Longhu People's Hospital, Shantou, China.
Guangshao WenEmergency Department, Dabu Counrty People's Hospital, Meizhou, China.
Yan HeEmergency Department, Zhuhai People's Hospital, Zhuhai, China.
Jian WuEmergency Department, Pengpai Memorial Hospital, Shanwei, China.
Qunlin ChenEmergency Department, Shanwei Yihui Fund Hospital (The Second People's Hospital of Shanwei), Shanwei, China.
Chuming LiuEmergency Department, Qingcheng District People's Hospital, Qingyuan, China.
Zhixue HuaEmergency Department, Yangshan County People's Hospital, Qingyuan, China.
Xiaoyan YangEmergency Department, Chaozhou Central Hospital, Chaozhou, China.
Keke WangEmergency Department, First Affiliated Hospital of SunYat-sen University, Guangzhou, China.
Jiasong HuEmergency Department, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Changqing MaoEmergency Department, SunYat-sen University Affiliated, Third Hospital Yuedong Hospital, Meizhou, China.
Jianfei LiEmergency Department, The Second People's Hospital of Zhaoqing, Zhaoqing, China.
Ping SongEmergency Department, Shenzhen Children's Hospital, Shenzhen, China.
Chunfa JiangEmergency Department, Houjie Hospital of Dongguan, Dongguan, China.
Weiqin ZhongEmergency Department, Maonan District People's Hospital, Maoming, China.
Xiaoyue LiEmergency Department, Fifth Affiliated Hospital of Zunyi Medical College, Zhuhai, China.
Jialuan ZhangEmergency Department, Yangshan County Traditional Chinese Medicine Hospital, Qingyuan, China.
Bei HuEmergency Department, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
Youqing TangEmergency Department, Guangdong Second People's Hospital, Guangzhou, China.
Zhiming LianEmergency Department, Guangzhou Hospital of Integrated Chinese and Western Medicine, Guangzhou, China.
Li LiuEmergency Department, Chenghai District People's Hospital, Shantou, China.
Wenyue LiuEmergency Department, Jiaoling People's Hospital, Meizhou, China.
Qihua WuEmergency Department, Guangning County People's Hospital, Zhaoqing, China.
Yaling ChaiEmergency Department, Shenzhen Longhua People's Hospital, Shenzhen, China.
Xiaoming LaiEmergency Department, Lianping County People's Hospital, Heyuan, China.
Yong ZhengEmergency Department, Qingxin District People's Hospital, Qingyuan, China.
Yuanwen LuEmergency Department, Yingde City Hospital of Traditional Chinese Medicine, Qingyuan, China.
Dianhong LiEmergency Department, Guangdong Second Hospital of Traditional Chinese Medicine, Guangzhou, China.
Zhipeng ZhouEmergency Department, Guangzhou Red Cross Hospital, Guangzhou, China.
Qiutian LinEmergency Department, Traditional Chinese Medicine Hospital of PuningCity, Jieyang, China.
Guangda LiangEmergency Department, Yangjiang Hospital of Traditional Chinese Medicine, Yangjiang, China.
Huayuan ZhuEmergency Department, Fengshun County People's Hospital, Meizhou, China.
Feng ZhongEmergency Department, Qishi Hospital of Dongguan, Dongguan, China.
Mingjun DuEmergency Department, The Sixth Affiliated Hospital of Jinan University, Dongguan, China.
Yue HuangEmergency Department, Foshan Fifth People's Hospital, Foshan, China.
Xingdong ZengEmergency Department, Rulin Bay Integrated Traditional Chinese and Western Medicine Hospital of Nanhai District, Foshan, China.
Huaqing ZhanEmergency Department, The Third People's Hospital of Shunde, Foshan, China.
Fengxi WangEmergency Department, Leliu Hospital of Shunde, Foshan, China.
Wenzhong YuEmergency Department, Yunan County People's Hospital, Yunfu, China.
Pengcheng WuEmergency Departmentt, Zhongshan Torch Development Zone People's Hospital, Zhongshan, China.
Ruiquan WangEmergency Department, First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China.
Bo LiuEmergency Department, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Lintao YuEmergency Department, Third Affiliated Hospital of Southern Medical University, Guangzhou, China.
Chao ChenEmergency Department, Baiyun Hospital of The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
Haidong WuEmergency Department, Eighth Affiliated Hospital of Sun Yat-sen Uni versity, Shenzhen, China.
Zhenggeng WuEmergency Department, Southern University of Science and Technology Hospital, Shenzhen, China.
Lanxiang WangEmergency Department, Shenzhen Luohu People's Hospital, Shenzhen, China.
Linfeng ZhangEmergency Department, Zhangmutou Hospital of Dongguan, Dongguan, China.
Tengfei GuoEmergency Department, Fenggang Hospital of Dongguan, Dongguan, China.
Wenliang XiaoEmergency Department, Shijie Hospital of Dongguan, Dongguan, China.
Guoyan LiEmergency Department, Nanhai District Hospital of TCM, Foshan, China.
Shaoyi LinEmergency Department, Longjiang Hospital of Shunde, Foshan, China.
Fuhua YanEmergency Department, Zhongshan Guzhen People's Hospital, Zhongshan, China.
Yufeng GaoEmergency Department, Guangzhou twelfth People's Hospital, Guangzhou, China.
Yukun ChenEmergency Department, Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Haixia WangEmergency Department, Huiya Hospital of the First Affiliated Hospital of Sun Yat-sen University, Huizhou, China.
Ruisui ChenEmergency Department, Dinghu District People's Hospital, Zhaoqing, China.
Donghua GuEmergency Department, Zhaoqing Gaoyao District Traditional Chinese Medicine Hospital, Zhaoqing, China.
Weicong ZhengEmergency Department, Guangning County Hospital of Traditional Chinese Medicine, Zhaoqing, China.
Cong LiangEmergency Department, The Second People's Hospital of Fengkai, Zhaoqing, China.
Yuetao ZhangEmergency Department, Fengkai Hospital of Traditional Chinese Medicine, Zhaoqing, China.
Yanli WangEmergency Department, University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
Xu FengEmergency Department, Longgang People's Hospital, Shenzhen, China.
Fuquan XiaoEmergency Department, Wengyuan County Hospital of Traditional Chinese Medicine, Heyuan, China.
Xuemin HuangEmergency Department, Xinfeng People's Hospital, Shaoguan, China.
Guisheng LiaoEmergency Department, Dongguan Eighth People's Hospital, Dongguan, China.
Yaogen YuanEmergency Department, Gaobu Hospital of Dongguan, Dongguan, China.
Shaofeng DengEmergency Department, Qiaotou Hospital of Dongguan, Dongguan, China.
Quanle LiuEmergency Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Zhuhai, China.
Zhenliang ZhengEmergency Department, Dongyuan County People's Hospital, Heyuan, China.
Yongbiao ZhangEmergency Department, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China. zhyongb@mail.sysu.edu.cn.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesNon-neonatal tetanus continues to pose a public health challenge in low- and middle-income regions. This study aimed to describe the decade-long profile of non-neonatal tetanus in Guangdong, China, from 2011 to 2021—a period marked by rapid economic development and healthcare system strengthening.
designMulticenter, retrospective study.
settingThe study was conducted across 159 hospitals in Guangdong, China. PATIENTS: We included patients with a clinical diagnosis of tetanus admitted between 2011 and 2021. A total of 2,567 cases (median age 53 years; 62.1% male) were analyzed.
interventionsNone. MEASUREMENTS AND MAIN
resultsData on demographics, vaccination status, clinical severity (Ablett classification), etiology, seasonal trends, critical care utilization, outcomes, and costs were collected. Farmers constituted the largest occupational group (43.7%), and only 2.2% had documented tetanus vaccination. Hospitalizations fluctuated but showed an overall increase, with a rising proportion of severe cases (Ablett grade III/IV). A seasonal peak was observed in August–September. The most common etiology was post-traumatic injury (43.4%). Critical care was frequently required: 25.1% of patients were admitted to the ICU, and 23.8% received mechanical ventilation. Multivariable analysis identified higher Ablett grade, injection drug use, unknown etiology, and comorbidities as independent risk factors for mortality; ICU admission was protective. Case fatality declined significantly from 11.8% in 2012 to 3.5% in 2021, while median hospitalization costs rose substantially.
conclusionsThis large-scale study reveals a substantial burden of severe non-neonatal tetanus among under-vaccinated adults, persisting despite the region’s economic transition. Case fatality decreased over the study period, likely reflecting improvements in both the accessibility and quality of critical care, albeit with increasing healthcare costs. The association between injection drug use or unknown etiology and mortality warrants heightened clinical vigilance.
Indexed as
HospitalizationTetanusAdultAgedChinaFemaleHumansMaleMiddle AgedRetrospective StudiesCritical careEpidemiologyHospitalizationRetrospective studyTetanus
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